SIMPLE STRESS FRACTURES? ARE THEY UNDER-INVESTIGATED?

Introduction Stress fractures in the foot are common; the common practice is to look for any factor in the history or for any foot deformity that could cause the fracture. Once found, it is common to treat the fractures without further investigations. The aim of this study is to assess if we are missing any underlying metabolic disorder associated with such injury. Materials and methods We studied 34 sequential cases referred for chronic foot pain. Stress fractures were confirmed either by classic x-ray9s features or MRI. Clinical examination and further tests were performed for Vitamin D levels, Thyroid function, PTH, DEXA scan, Biochemical and bone profile. All stress fractures were treated conservatively. Results Mean age was 50 (13–72) (22 Females, 9 Males), 29 patients were fit and healthy ASA 1, 5 cases were ASA 2. 12 cases presented with a precipitating event. 14 cases had a minor foot deformity (such as hallux valgus of minor pes planus). mean BMI 27.6. The blood tests newly diagnosed: 17 Vitamin D deficiencies cases, 2 hyperparathyroidism cases, one case of Cushing9s Syndrome secondary to adrenal adenoma and one case of delay in puberty in addition to 3 osteoporosis cases. All fractures responded to conservative means of treatment and none needed surgical interventions. Discussion The study shows that the incidence of endocrinological disorders is patients presenting with stress fractures is much higher than the incidence in the general population; for example the incidence of Cushing9s syndrome is 1 per 130000 individuals while in our series was 1 per 34. This study raises the question if all patients presetting with stress fractures should be investigated for endocrinological disorders.